Psychiatry International

Objective: To review and synthesize the current literature of clinical trials that investigated the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in people with obstructive sleep apnea (OSA). Method: MEDLINE, EMBASE, Cochrane Library, and PsycINFO were searched for randomized controlled trials (RCTs) in which GLP-1RAs were used to treat people diagnosed with OSA. This systematic review and meta-analysis complied with PRISMA 2020 guidelines and was registered on PROSPERO (CRD42024537280). A random effects model was used for meta-analysis to assess changes in OSA as measured by the apnea–hypopnea index (AHI) compared to continuous positive airway pressure (CPAP) or placebo controls. The standardized mean difference (SMD) and risk ratio (RR) were computed for continuous and binary outcomes. Variability between studies, risk of bias, subgroup analysis, and leave-one-out analysis were completed. Results: Five studies were included (N = 1023; 511 GLP-1RA and 512 control). Two trials used tirzepatide and four studies used liraglutide as the GLP-1RA. Six studies showed a decrease in AHI with an SMD of −14.5 events per hour (95%CI = −24.73 to −4.21; I² = 96.3%). When compared to placebo, GLP-1RA treatment had a significant reduction in AHI (SMD = −0.69; 95%CI = −1.10 to −0.26; p = 0.001; I² = 88.0%). When compared to CPAP, no significant difference in the reduction of AHI was found. No evidence of publication bias was found. Compared to control, there was no significant difference in serious adverse events (RR = 0.89; 95%CI = 0.50 to 1.57; p = 0.68; I² = 20.93%). Conclusions: People with psychiatric disorders may also experience comorbid OSA that can impact their quality of life, which may perpetuate psychiatric symptoms of depression. GLP-1RAs may provide therapeutic potential in the treatment of OSA in addition to their cardioprotective effects. Current studies are limited by small sample sizes, lack of blinding, and short duration. Future studies will require further investigation in long-term efficacy and safety. Full article

Person-centered care emphasizes shared decision-making and a holistic approach to support patient autonomy. This scoping review aimed to clarify the definitions and approaches of person-centered physical rehabilitation (PCPR) that satisfy patients with schizophrenia and to identify specific methods to increase their satisfaction. Methods: This scoping review was conducted in accordance with the recommendations of the Joanna Briggs Institute and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The studies were screened, the data were extracted, and the findings were charted. Results: PCPR is an individually optimized rehabilitation approach that is centered around the “person” and is aimed at supporting the entire life of the individual, while respecting their values and wishes. This approach emphasizes the importance of patients actively participating in their own treatment and enhancing their self-management abilities rather than relying solely on medical techniques. PCPR involves empowering patients, particularly patients with schizophrenia; establishing comprehensive rehabilitation plans; and adopting flexible responses. Conclusions: Effective PCPR enhances healthcare providers’ moral sensitivity and ability to manage complex needs, thereby improving patient satisfaction and motivation to join physical rehabilitation. Furthermore, to conduct PCPR for patients with schizophrenia effectively, it is crucial to provide not only physical rehabilitation, but also appropriate psychosocial support, and to promote the establishment and maintenance of healthy lifestyle habits. Full article

The COVID-19 pandemic has had a profound impact on mental health globally, especially among users of primary health care (PHC) services. This systematic review aims to synthesize the current evidence on the prevalence and associated factors of depression, anxiety, and stress among adult PHC users in Europe during the post-pandemic period. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251033455). We searched Web of Science, PubMed, b-on, and Scopus up to April 2025. Eligible studies included peer-reviewed, quantitative observational studies conducted in Europe from 2022 onward, provided they addressed the post-pandemic context and assessed depression, anxiety, and/or stress using validated tools. Two reviewers independently screened the studies and performed data extraction. The risk of bias was assessed using the ROBINS-I tool. A narrative synthesis of the findings was subsequently conducted. A total of 11 studies involving 8958 participants were included in this analysis. Most studies were cross-sectional and employed tools such as the DASS-21, PHQ-9, and HADS. The prevalence of depressive symptoms reached up to 63%, and anxiety affected over 40% of participants in several studies. Vulnerable groups included women, individuals with chronic illnesses, those unemployed, and persons living alone or facing financial hardship. The risk of bias was moderate to serious in most studies. The evidence highlights significant post-pandemic psychological distress, conceptualized as symptoms of depression, anxiety, and stress measured through validated psychometric instruments, in PHC settings, with underdiagnosis remaining a key issue. Limitations include heterogeneity in assessment tools and designs, as well as reliance on self-report measures. Results underscore the need for routine mental health screening and integrated care in PHC. This review received no specific funding. Full article

Background: Borderline personality disorder (BPD), a significant personality trait frequently observed in young adults, is associated with challenges in mental health and academic performance. Screening for BPD symptoms is essential. The Screening Instrument for Borderline Personality Disorder (SI-Bord) is widely used to assess general BPD symptoms. However, despite being translated and culturally adapted, the psychometric properties of the Chinese version of the SI-Bord have not been thoroughly investigated in a Chinese population. Objectives: The aim of the study was to evaluate the psychometric properties of the Chinese version of the Screening Instrument for Borderline Personality Disorder (SI-Bord) among university students using confirmatory factor analysis (CFA). Methods: Participants completed the SI-Bord along with the Perceived Stress Scale (PSS), the Meaning in Life Questionnaire (MLQ), the Experiences in Close Relationships–Revised (ECR-R), and the Rosenberg Self-Esteem Scale (RSES). Results: A total of 715 Chinese university students (mean age = 20.33 years; age range = 18–25), including 385 males (54.2%) and 325 females (45.5%), participated in this study. The unidimensional model demonstrated adequate fit indices. The SI-Bord showed significant correlations with the PSS and ECR-R (attachment anxiety), alongside smaller correlations with the MLQ, supporting its convergent and discriminant validity. The Chinese version of the SI-Bord exhibited good reliability. Invariance testing confirmed at least metric invariance across various groups. Conclusions: The Chinese version of the SI-Bord demonstrates strong validity and reliability as a tool for screening for core BPD symptoms among Chinese university students. Further studies are encouraged to evaluate the validity of the SI-Bord across diverse groups, including age, socioeconomic status, and geographic regions. Applying it in clinical BPD samples will further enhance its utility across Chinese populations. Full article

The gut microbiota plays an essential role in human health, influencing gut–brain communication. Imbalances in this microbial ecosystem, termed dysbiosis, have been associated with increased gut permeability and gastrointestinal symptoms commonly reported in autism spectrum disorder (ASD), without implying a direct causal role in ASD itself. This study aimed to determine whether alterations in gut microbiota exist in individuals with Fragile X Syndrome (FXS), with or without ASD, compared to ASD patients and neurotypical controls, and to identify microbiota biomarkers associated with these disorders. Stool samples from Caucasian individuals aged 3–18 years belonging to four groups (ASD, FXS, FXS + ASD, and controls) were analysed by amplifying the V3–V4 region of the bacterial 16S rRNA gene to characterize microbiota composition. Significant differences were found among patient groups compared to neurotypical controls, with notable similarities between the ASD and FXS + ASD groups. Additionally, specific microbiota biomarkers were identified for each patient group. These findings suggest that distinct microbiota alterations are associated with FXS and ASD, which may contribute to a more accurate characterization of symptoms in these disorders and could serve as potential biomarkers for assessing neurodevelopmental risk. Full article

The transition to university is a critical period for establishing lifelong health habits, particularly in Saudi Arabia, where non-communicable diseases linked to lifestyle are increasingly prevalent. To address this, our study sought to comprehensively assess lifestyle behaviors, mental health status, and their combined impact on health-related quality of life (HRQoL) among students at King Khalid University. We conducted a cross-sectional study between September 2024 and February 2025, recruiting 865 undergraduates via a two-stage stratified random sampling technique. Data were collected using a validated online questionnaire that included the FANTASTIC lifestyle and EuroQol 5-Dimension 3-Level (EQ-5D-3L) instruments. Our study population exhibited a significant health burden; 37.6% were overweight or obese, 55.9% reported anxiety or depression, and 36.1% experienced pain or discomfort. Although the mean lifestyle score was generally positive, regression analysis revealed that anxiety/depression was the strongest predictor of a poorer lifestyle (OR = 2.94, 95% CI: 2.02–4.28). This study concludes that a profound negative association exists between mental health, lifestyle, and overall HRQoL, highlighting the urgent need for integrated wellness policies and support systems within the university setting to address these interconnected challenges. Full article

Climate change and its consequences for human beings are considered to be a major mental health problem, commonly referred to as ‘climate anxiety’. This particular form of anxiety is currently the subject of extensive research. Research is investigating its relationship to more general forms of anxiety as well as the coping strategies that can be put in place to manage it. The present study was conducted to examine the role of variables such as age, trait anxiety, tenacious goal pursuit, and flexible goal adjustment on climate-related anxiety. A cross-sectional study was conducted in which 396 participants completed the questionnaire. Hierarchical multiple regression analysis was used to analyze the data. Results from the hierarchical regression model revealed that age, trait anxiety and flexible goal adjustment had a positive and significant effect on climate anxiety scores. In this study, the older the young participants are, the higher their trait anxiety scores, and the higher their levels of flexible goal adjustment, the more climate anxiety they experience. Contrary to our hypotheses, flexible goal adjustment was positively associated with climate anxiety, suggesting that accommodative coping may in some contexts amplify rather than alleviate emotional distress. This study highlights the increased vulnerability to climate anxiety of older participants among the young adults with trait anxiety and higher levels of accommodative coping strategies (i.e., FGA). These findings provide some guidelines for clinical practice, in particular by questioning educational intervention and cognitive flexibility in young adults. Full article

Background: Schizophrenia is a complex neuropsychiatric disorder whose pathophysiology may involve oxidative stress-induced neuronal damage and inflammation. We conducted a cross-species study to elucidate oxidative stress dysregulation in schizophrenia. Methods: We measured peripheral oxidative stress biomarkers (malondialdehyde [MDA], nitric oxide [NO], reduced glutathione [GSH], superoxide dismutase [SOD], catalase [CAT], advanced protein oxidation products [APOP]), and C-reactive protein (CRP) in antipsychotic-naïve schizophrenia patients and matched controls. We also assayed liver enzymes (ALP, ALT, AST) as indicators of systemic metabolic stress. In parallel, we re-analyzed published single-cell RNA-sequencing data from a Setd1a^+/–^ mouse model of schizophrenia, focusing on prefrontal cortex (PFC) cell types and oxidative stress-related gene expression. Results: Patients with schizophrenia showed markedly elevated MDA and NO (indicators of lipid and nitrosative stress) and significantly reduced antioxidant defenses (GSH, SOD, CAT) versus controls (p < 0.01 for all comparisons). Notably, urban patients exhibited higher oxidative stress biomarker levels than rural patients, implicating environmental contributions. Liver function tests revealed increased ALT, AST, and ALP in schizophrenia, suggesting hepatic/metabolic dysregulation. Single-cell analysis confirmed dysregulated redox pathways in the schizophrenia model; PFC neurons from Setd1a^+/–^ mice displayed significantly lower expression of key antioxidant genes (e.g., Gpx4, Nfe2l2) compared to wild-type, indicating impaired glutathione metabolism. Conclusions: Our integrative data identify convergent oxidative stress imbalances in schizophrenia across species. These findings advance a mechanistic understanding of schizophrenia as a disorder of redox dysregulation and inflammation. They also have translational implications as augmenting antioxidant defenses (for example, with N-acetylcysteine or vitamins C/E) could mitigate oxidative injury and neuroinflammation in schizophrenia, representing a promising adjunct to antipsychotic therapy. Full article

The transition from secondary to higher education presents numerous academic, social, and psychological challenges that can negatively impact students’ well-being, particularly during the first year. This randomized controlled trial aimed to evaluate the effectiveness of hypnosis as a non-pharmacological intervention for managing perceived stress among first-year nursing students at the Higher Institute of Nursing and Health Techniques (ISPITS) in Rabat, Morocco. A total of 166 students from five academic tracks were randomly assigned to intervention and control groups with comparable baseline characteristics. Their perceived stress levels were assessed using two validated instruments, the Visual Analog Scale (VAS) and the 14-item Perceived Stress Scale (PSS-14), administered before and after a five-session hypnosis program conducted over 10 weeks. The results showed a marked and statistically significant reduction in stress among the intervention group, with the mean VAS scores decreasing from 7.82 ± 2.05 to 3.00 ± 1.71 compared to a smaller reduction in the control group (from 7.65 ± 1.78 to 5.80 ± 1.72; between-group difference = 2.8, p < 0.0001). Similarly, the PSS-14 scores in the intervention group declined significantly from 26.42 ± 7.54 (moderate stress) to 24.32 ± 8.20 (still moderate), with a mean difference of 2.09 ± 7.70 (t = 2.21, p = 0.0307, 95% CI [0.20; 3.98]). These findings indicate that hypnosis is an effective mind–body approach for alleviating perceived stress, improving emotional regulation, and could be incorporated into academic support programs to enhance student well-being. Full article

In terms of occupational health and safety, psychosocial risks in the workplace can lead to temporary or permanent harm. Search and rescue workers assisting earthquake victims may develop PTSD due to the trauma they experience and witness. This study estimates the prevalence of PTSD among search and rescue workers involved in the February 6, 2023, earthquake in Türkiye. This study utilized the PTSD Checklist for DSM-5 (PCL-5) to assess 619 individuals. The results showed that the earthquake significantly affected post-traumatic stress symptoms across all demographic groups. Female participants (x̄ = 2.43) exhibited higher stress levels than male participants (x̄ = 2.24), showing an 8.48% difference. Participants with higher education levels (x̄ = 2.34) showed more stress than those with lower education (x̄ = 1.67). Individuals with over a decade of experience (x̄ = 3.28) experienced more distress compared to those with less than three years of experience (x̄ = 2.83). Participants under 30 (x̄ = 2.30) were more affected than those over 50 (x̄ = 2.25). Firsthand experience of the earthquake (x̄ = 2.49) resulted in greater distress compared to learning about it through communication channels (x̄ = 2.01). Concerning PTSD symptoms, 191 participants (30.86%) scored 33 or higher, which indicates clinically significant PTSD. Among the participants, 22 experienced severe to extremely severe symptoms, with 19 showing extremely severe symptoms on at least one subscale, 3 displaying extremely severe symptoms across all four subscales, and 9 demonstrating extremely severe symptoms in three subscales. Full article

Burnout, characterized by emotional exhaustion and depersonalization, is increasingly recognized as a significant mental health concern with psychiatric implications. This cross-sectional study explored variables associated with current burnout levels among 2004 teachers in 19 Latin American countries and Spain, drawing on retrospective perceptions of COVID-19 pandemic-related changes in work conditions and student behavior. Using a comprehensive survey, researchers gathered demographic information, work-related characteristics, and burnout levels measured by the Maslach Burnout Inventory. Participants were recruited through social media platforms and teacher groups. Participants reported high emotional exhaustion, with 45.9% exceeding the clinical threshold. Moderate depersonalization levels were observed, with 30.2% scoring above the clinical cutoff. Hierarchical regressions indicated that emotional exhaustion was significantly predicted by individual (e.g., gender, age, socioeconomic status, pre-existing mental and chronic illnesses), school (e.g., school level, sector, and workload), and student factors (e.g., behavior and social adjustment problems), accounting for 17.4% of the variance. Depersonalization was similarly associated with individual (e.g., gender, age, education, and pre-existing mental illness), school (e.g., workload and school level), and student characteristics (e.g., educational, behavioral, and family adjustment problems), explaining 6.5% of the variance. These findings contribute to psychiatric and psychological research by identifying specific risk profiles for chronic stress syndromes in educators—an occupational group facing long-term psychological impacts from the COVID-19 crisis. This study underscores the need for interdisciplinary psychiatric approaches to diagnose and prevent burnout and promote teacher well-being through clinical and policy-level interventions. Full article

Mental health professionals are often confronted with clients’ traumatic narratives, which may lead to increased levels of vicarious trauma and burnout, especially when work-related risk factors are present. This study aims to investigate the relationship between vicarious trauma and burnout among mental health professionals in Greece while taking into account work-related and intrapersonal factors using a sample of 266 mental health professionals, who completed the Core Self-Evaluations Scale, Self-Compassion Scale, Vicarious Trauma Scale, and Counselor Burnout Inventory, and provided information about work-related variables, such as caseload, clinical supervision, clinical training, and therapeutic experience. The findings showed that Greek mental health professionals’ burnout positively associated with vicarious trauma and caseload, while negatively associated with intrapersonal factors and work-related factors, namely, years of clinical supervision, clinical training and therapeutic experience. Vicarious trauma negatively correlated with core self-evaluations, self-compassion, and clinical experience. Finally, low core self-evaluations and self-compassion were found to explain greater burnout levels together with higher vicarious trauma and work overload per week, while core self-evaluations were the only variable that moderated the relationship between vicarious trauma and burnout of Greek mental health professionals. These findings indicate that in order to address the interplay between vicarious trauma and burnout, targeted interventions that focus on personal attributes, coping strategies, and systemic organizational support are needed. Full article

Objectives: Migrants are at greater risk of psychiatric hospitalization. This study aims to improve care for migrants hospitalized in psychiatric wards in Morocco by studying comprehensive clinical and epidemiological characteristics, focusing on potential risk factors to guide mental health intervention efforts. Methods: The present retrospective multicenter study retrieved sociodemographic, clinical data, and patient records of migrants admitted to a large Moroccan psychiatric hospital in the Rabat region between 2013 and 2023 in order to delineate characteristics and risk factors for psychiatric hospitalizations. Descriptive and univariable analyses were conducted using chi-square, Fisher’s exact, and Mann–Whitney tests, and multivariable logistic regression analyses were performed by Jamovi 2.3.28.0 software to predict rehospitalization. Results: A total of 102 patient files were analyzed. Of these, 72.5% were single men, 27.5% had mental health problems prior to migration, 23.5% had attempted suicide, and 88.2% had negative insight. Some 94.86% were hospitalized against their will, 73.5% were diagnosed with psychosis, and only 2 were diagnosed with a stress-related disorder. Some 34.3% were hospitalized. Factors significantly associated with hospitalized were divorced family status, presence of psychotic pathology, and number of family members between five and nine with OR = 5.28, CI [1.04–26.68], p = 0.044; OR = 5.95, CI [2.02–17.44], p = 0.001; and OR = 6.02, CI [1.71–21.11], p = 0.005, respectively. Shorter length of stay in Morocco, unemployment, asylum seekers, and use of restraints were more frequent in hospitalized patients. Conclusions: Identifying at-risk migrants and setting up culturally appropriate, trauma-informed services can reduce the number of hospital admissions and boost the training and awareness of healthcare professionals in this area. Full article

This study examined burnout syndrome (BS) levels in 133 Colombian health professionals, aiming to identify its prevalence and evaluate the psychometric properties of the CESQT scale. The first aim was to determine the presence of BS during the initial peak of COVID-19 infections in Colombia, revealing generally low levels among participants. The second aim involved an exploratory factor analysis (EFA) of the CESQT, which confirmed its alignment with the theoretical and psychometric model of the original Spanish version and the Colombian adaptation, demonstrating good internal consistency and a four-dimensional structure. Finally, the relationship between the MBI-HSS and CESQT scales was explored, showing statistically significant correlations that support convergent validity. These findings enhance the understanding and measurement of BS in health professionals and offer insights for intervention, prevention, and mental health promotion aimed at improving healthcare services quality in Colombia. Full article

Background: Bullying is a significant problem worldwide and in Lithuania, especially among children and adolescents. This study aimed to assess the associations of bullying with adolescents’ subjective sense of happiness and general health. Methods: A cross-sectional study was conducted using an anonymous written questionnaire. Adolescents at various schools across Lithuanian cities and districts were surveyed to investigate the frequency of bullying among them over the past six months and its impact on their subjective sense of happiness and well-being. Results: This study included 4124 students from seventh to tenth grade; their average age was 14.48 ± 1.15 years, with 49.35% being boys. Over the past six months, the highest bullying incidence occurred at school, accounting for 25.79% of the cases. Only half of the respondents (48.81%) felt happy, and a little more than half felt healthy (63.11%). It was found that bullying at school (ρ_s = −0.224; ρ_s = −0.197), outside school (ρ_s = −0.207; ρ_s = −0.180), and online (ρ_s = −0.175; ρ_s = −0.110) is associated with adolescents’ sense of happiness and health. Conclusion: Bullying is common among Lithuanian adolescents and has a negative impact on their subjective happiness and well-being. It is crucial to develop prevention initiatives to decrease bullying in schools and within the community. Full article

Family empowerment is a key component of effective family-centered practices in healthcare, mental health, and educational services. The Family Empowerment Scale (FES) is the most commonly used instrument to evaluate empowerment in families raising children with emotional, behavioral, or developmental disorders. Despite its importance, the FES for diverse populations, especially Latinx parents, has rarely been evaluated using innovative psychometric approaches. In this study, we evaluated key dimensions and psychometric evidence of the Family Empowerment Scale (FES) for 96 Latinx parents of children with intellectual and developmental disabilities (IDD) in the United States using an exploratory graph analysis (EGA). The EGA identified a five-dimensional structure, and EGA models outperformed the original CFA 3-factor models for both parents of children with autism and other disabilities. This study identified distinct, meaningful dimensions of empowerment that reflect both shared and unique empowerment experiences across two Latinx parent groups. These insights can inform the design of culturally responsive interventions, instruments, and policies that more precisely capture and boost empowerment in Latinx families. This study contributes to closing a gap in the literature by elevating the voices and experiences of Latinx families by laying the groundwork for more equitable support systems in special education and disability services. Full article

The problem associated with the manifestation of burnout syndrome is the subject of ongoing interest. In recent years, occupational burnout has been actively studied among professionals in the helping professions (teachers, physicians, social workers, psychologists, prison officers, etc.). However, the phenomenon has been poorly studied among freelancers. Therefore, the aim of this study is to fill this gap by determining the level of burnout syndrome among Bulgarian freelancers and investigate the influence of some work environment factors on professional burnout in the sample. A survey of 1138 freelancers was carried out using the Burnout Self-Assessment Questionnaire developed by Maslach and a questionnaire developed in-house to explore the factors of the occupational environment and ask questions related to socio-demographic factors. Hypotheses are tested using correlation analysis and structural equation modelling. The study reveals high levels of emotional exhaustion (40.91%, n = 484). High values on the scale of depersonalization were reported for 26,3% of the respondents (n = 311). Only 3.1% of the respondents (n = 37) had high values on the reduced personal accomplishment scale. The high levels of burnout among freelancers could be influenced by the specific characteristics of their work environment and the nature of their tasks. Full article

Background: About half of all Major Depressive Disorder (MDD) patients have anxiety disorder. There is a neurologic basis for the comorbidity of balance (vestibular) disorders and anxiety. To detect comorbid anxiety disorder in MDD patients and, importantly, to investigate its relationship with depressive severity, we use Electrovestibulography (EVestG), which is predominantly a measure of vestibular response. Methods: In a population of 42 (26 with anxiety disorder) MDD patients, EVestG signals were measured. Fourteen (eight with anxiety disorder) were not on any anti-depressants, anti-psychotics or mood stabilizers. Using standard questionnaires, participants were depression-wise labelled as reduced symptomatic (MADRS ≤ 19, R) or symptomatic (MADRS > 19, S) as well as with or without anxiety disorder. Analyses were conducted on the whole data set, matched (age/gender/MADRS) subsets and compared with medication free subsets. Low-frequency EVestG firing pattern modulation was measured. Results: The main differences between MDD populations with and without anxiety disorder populations, regardless of being medicated or not, were (1) the presence of an increased 10.8 Hz component in the dynamic movement phase recordings, (2) the presence of asymmetric right versus left 7.6–8.9 Hz and 12.1–13.8 Hz frequency bands in the no motion (static) phase recordings, and (3) these differences were dependent on depressive severity. Conclusions: The EVestG measures are capable of quantifying anxiety in MDD patients. These measures are functions of depressive severity and are hypothesized to be linked to Hippocampal Theta (~4–12 Hz). Full article

Clozapine, a second-generation antipsychotic known for its effectiveness in treating resistant schizophrenia, is often linked with serious hematological side effects, particularly neutropenia and agranulocytosis. This review investigates the underlying pathophysiological mechanisms of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA), outlines associated risk factors, and evaluates current clinical management strategies. Clozapine’s pharmacological profile, marked by its antagonism of dopamine D4 and serotonin receptors, contributes to both its therapeutic advantages and hematological toxicity. Epidemiological data show a prevalence of CIN and CIA at approximately 3.8% and 0.9%, respectively, with onset typically occurring within the first six months of treatment. Key risk factors include older age, Asian and African American ethnicity, female sex, and certain genetic predispositions. The development of CIN and CIA may involve bone marrow suppression and autoimmune mechanisms, although the exact processes remain partially understood. Clinical presentation often includes nonspecific symptoms such as fever and signs of infection, necessitating regular hematological monitoring in accordance with established guidelines. Management strategies include dosage adjustments, cessation of clozapine, and the administration of granulocyte colony-stimulating factors (G-CSF). Advances in pharmacogenomics show promise for predicting susceptibility to CIN and CIA, potentially improving patient safety. This review emphasizes the importance of vigilant monitoring and personalized treatment approaches to reduce the risks associated with clozapine therapy. Full article